Failure to Implement Enhanced Barrier Precautions and Hand Hygiene During Wound Care
Penalty
Summary
The facility failed to implement its infection prevention and control program, specifically regarding enhanced barrier precautions and hand hygiene, for a resident with a wound. During wound care, an LPN did not post required signage for enhanced barrier precautions at the resident's door, did not wear a gown, and did not perform hand hygiene before donning gloves or with each glove change as required by facility policy. Supplies were gathered and placed on a barrier, but handwashing was omitted at key points during the procedure. The LPN stated that enhanced barrier precautions were not necessary for the resident's wound, believing it was not a chronic wound, and acknowledged not washing hands as required. The resident involved had diagnoses including altered mental status, morbid obesity, and a surgical wound requiring regular dressing changes per physician orders. Facility policies and posted signage required the use of gloves and gowns for wound care and specified hand hygiene before and after resident contact, before donning gloves, and after removing gloves. The DON initially stated that enhanced barrier precautions were only for chronic, unhealing wounds, but upon reviewing the policy, acknowledged that precautions should be used for any wound with an open healing area and dressing. The DON also confirmed that staff should perform hand hygiene when entering a resident's room and with each glove change.